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JAMA Intern Med. 2017 Nov 1;177(11):1613-1621. doi: 10.1001/jamainternmed.2017.4349.

Lung Cancer Mortality Associated With Smoking and Smoking Cessation Among People Living With HIV in the United States.

Reddy KP1,2,3, Kong CY3,4, Hyle EP1,3,5, Baggett TP3,6,7, Huang M1,3,8, Parker RA1,3,6,8, Paltiel AD9, Losina E3,10,11, Weinstein MC3,12, Freedberg KA1,3,5,6,12,13, Walensky RP1,3,5,6,14.

Author information

1
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston.
2
Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston.
3
Harvard Medical School, Boston, Massachusetts.
4
Institute for Technology Assessment, Massachusetts General Hospital, Boston.
5
Division of Infectious Diseases, Massachusetts General Hospital, Boston.
6
Division of General Internal Medicine, Massachusetts General Hospital, Boston.
7
Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston.
8
Biostatistics Center, Massachusetts General Hospital, Boston.
9
Yale School of Public Health, New Haven, Connecticut.
10
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
11
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
12
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
13
Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
14
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.

Abstract

Importance:

Lung cancer has become a leading cause of death among people living with human immunodeficiency virus (HIV) (PLWH). Over 40% of PLWH in the United States smoke cigarettes; HIV independently increases the risk of lung cancer.

Objective:

To project cumulative lung cancer mortality by smoking exposure among PLWH in care.

Design:

Using a validated microsimulation model of HIV, we applied standard demographic data and recent HIV/AIDS epidemiology statistics with specific details on smoking exposure, combining smoking status (current, former, or never) and intensity (heavy, moderate, or light). We stratified reported mortality rates attributable to lung cancer and other non-AIDS-related causes by smoking exposure and accounted for an HIV-conferred independent risk of lung cancer. Lung cancer mortality risk ratios (vs never smokers) for male and female current moderate smokers were 23.6 and 24.2, respectively, and for those who quit smoking at age 40 years were 4.3 and 4.5. In sensitivity analyses, we accounted for nonadherence to antiretroviral therapy (ART) and for a range of HIV-conferred risks of death from lung cancer and from other non-AIDS-related diseases (eg, cardiovascular disease).

Main Outcomes and Measures:

Cumulative lung cancer mortality by age 80 years (stratified by sex, age at entry to HIV care, and smoking exposure); total expected lung cancer deaths, accounting for nonadherence to ART.

Results:

Among 40-year-old men with HIV, estimated cumulative lung cancer mortality for heavy, moderate, and light smokers who continued to smoke was 28.9%, 23.0%, and 18.8%, respectively; for those who quit smoking at age 40 years, it was 7.9%, 6.1%, and 4.3%; and for never smokers, it was 1.6%. Among women, the corresponding mortality for current smokers was 27.8%, 20.9%, and 16.6%; for former smokers, it was 7.5%, 5.2%, and 3.7%; and for never smokers, it was 1.2%. ART-adherent individuals who continued to smoke were 6 to 13 times more likely to die from lung cancer than from traditional AIDS-related causes, depending on sex and smoking intensity. Due to greater AIDS-related mortality risks, individuals with incomplete ART adherence had higher overall mortality but lower lung cancer mortality. Applying model projections to the approximately 644 200 PLWH aged 20 to 64 in care in the United States, 59 900 (9.3%) are expected to die from lung cancer if smoking habits do not change.

Conclusions and Relevance:

Those PLWH who adhere to ART but smoke are substantially more likely to die from lung cancer than from AIDS-related causes.

PMID:
28975270
PMCID:
PMC5675744
DOI:
10.1001/jamainternmed.2017.4349
[Indexed for MEDLINE]
Free PMC Article

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